a world of difference

Friday, December 16, 2005

Rabbi: m.y.o.b. Health Dept.

The city's decision not to ban a circumcision practice that, the Health Department said, has lead to the death of at least one child wasn't likely to please the Christopher Hitchens types.But the Chasidic communities affected are also upset. They don't want the city to launch a public-information campaign warning people that the practice is dangerous.Williamsburg Rabbi David Niederman, speaking for the Central Rabbinical Congress, put out a largely conciliatory statement that ends on this note:"We have serious concerns about the Health Department's insistence on advising mothers of newborn boys concerning a religious practice. We believe that continuing the religious practice of metzitzah b'peh is highly safe. We will work with expectant mothers and fathers in our community to urge them to consult with their rabbis as they approach the blessed event of celebrating a bris for a newborn boy."...

In his Open Letter, Frieden reviews seven cases of herpes that have occurred locally, including two this year that the letter discloses publicly for the first time.

Health Department investigators have concluded all were transmitted by mohels performing metzitzah b’peh.

According to Frieden, in one of the two new cases, the infant shows evidence of severe brain damage. The case came to the Health Department’s attention in October.

Frieden said in neither case have the families been willing to identify the mohel who performed the circumcision.

“We are continuing to try to gain their cooperation,” he said.

In legal documents filed several months ago the department stated that herpes, which generally causes just blisters and cold sores in healthy older children and adults, is fatal as much as 30 percent of the time in newborns.

Frieden’s warning against the procedure comes more than a year after a cluster of three neonatal herpes cases were attributed to Rabbi Fischer.

Furthermore, The Jewish Week has learned, the warning comes a full five years after two senior pediatricians at Long Island Jewish Medical Center warned the city that metzitzah b’peh was putting the lives of Jewish infants at risk.

Dr. Philip Lanzkowsky, chief of staff of Schneider Children’s Hospital at Long Island Jewish hospital, said he and a colleague reached out to city health officials and members of Brooklyn’s haredi community about the danger in 2000. The physicians acted after determining that two cases of neonatal herpes brought to Schneider Hospital had been caused by metzitzah b’peh.

“I went to Brooklyn myself and met with rabbis and a representative of the Health Department,” said Lanzkowsky.

He said he acted without publicity at the time, explaining, “One of the things we didn’t want to happen was adverse publicity in the general media that might affect [ritual circumcision] in general. We wanted to deal with it in the local Jewish community.”

There is little doubt the city was aware of Lanzkowsky’s warning. In his open letter, Frieden cites Lanzkowsky’s investigation of the two cases, published in the March 2000 edition of the Pediatric Infectious Diseases Journal.

Asked why he thought the city was acting now, Lanzkowsky said, “Obviously they [the community] didn’t heed the first warning.” But after the death of a child last year, “I think the Department of Health, which carries a responsibility here, could not sit quiet.”

Last year the city began to investigate the suspected link to one local mohel of three herpes cases in 2003 and 2004. As it probed the link, some sectors of the Orthodox community lobbied city officials heavily not to interfere with the practice. That effort included a meeting in August between Mayor Michael Bloomberg and prominent members of the Satmar chasidic community based in Brooklyn and Rockland County as Bloomberg was gearing up for re-election.

“We’re going to do a study to make sure that everybody is safe, and at the same time it is not the government’s business to tell people how to practice their religion,” Bloomberg said one day after the meeting.

‘They Haven’t Banned It’

Frieden issued his statement in two parts: the open letter and a flier titled “Before the Bris: How to Protect Your Infant Against Herpes Virus Infection Caused by Metzitzah B’peh.”

The latter is a one-page “fact sheet” the city intends to distribute directly to new parents at hospitals frequently used by Jewish mothers to give birth, circumventing religious authorities who maintain that metzitzah b’peh is an essential element of brit milah, or ritual circumcision.

The fact sheet introduces options that Jewish parents could have for the ritual circumcision of their new sons — information they might not receive from within sectors of the community insisting on metzitzah b’peh. The fact sheet and letter are also on the Health Department’s Web site, www.nyc.gov/html/doh/html/std/std-bris.shtml.

The flier begins with the statement “circumcision has health benefits,” but goes on to explain how herpes is contracted from mohels who employ metzitzah b’peh and encourages parents to “consider other options.”

It takes aim squarely at arguments offered by some fervently Orthodox community leaders in the last few months claiming the practice is safe.

“There is no proven way to reduce the risk of metzitzah b’peh,” the flier says. “Although a mohel may use oral rinses or sip wine before metzitzah b’peh, there is no evidence that these actions reduce the spread of herpes. A mohel who takes antiviral medication may reduce the risk of spreading herpes virus during metzitzah b’peh, but there is no evidence that taking medication eliminates this risk.”

Other members of the haredi community joined Rabbi Niederman in expressing concern over the Health Department’s action.

David Zwiebel, an attorney and executive vice president of Agudath Israel, an organization that represents haredi interests, said he would have preferred the statement not be issued.

But at least “they have been true to their commitment that they would not regulate the procedure,” he said of Health Department officials. “They haven’t banned it and haven’t required some sort of informed consent, which was an idea on the table at an earlier stage.”

Zwiebel was concerned that the department’s action could harm the haredi community’s public image and serve as a “foundation on which other jurisdictions might choose to regulate the practice, or even New York City might do that at some future date.”

Haredi communities often view government agencies as interlopers meddling dangerously with their internal religious affairs. In this case the Health Department’s statement may prompt some to ask questions of their rabbis, Zwiebel said.

“The most likely reaction is that there will be a general message from many of these rabbonim to their communities whether or not — and probably not — the statement from the commissioner could impact their halachic practice,” he said.

Rabbi Levi Heber is a mohel based in Crown Heights, from the Lubavitch community, where metzitzah b’peh is considered a spiritually integral part of the brit milah ritual.

“The concept of non-Jewish authorities trying to influence certain behaviors should not be accepted by anyone,” said Rabbi Heber. “You never know where it could lead.”

Since the potential health risks of metzitzah b’peh hit the headlines, many clients have brought up concerns about it, Rabbi Heber said. “It’s something that’s been brewing.”

But parents “are sincerely interested in finding out the facts, and with a little bit of explanation they agree to it,” he said.

Rabbi Heber said he has never refrained from metzitzah b’peh because of a parental objection, but has had parents say “ ‘do what you have to do, but I’m not going to be there’ ” to see it.

Rabbi Niederman stressed the huge number of metzitzah b’peh procedures performed with no apparent ill effects.

“There have been seven cases, allegedly over a span of 15 years,” he said. “In Williamsburg alone we have close to 57,000 people. The overwhelming majority is very young, so you’re talking about 120,000 brises of metzitzah b’peh. You tell me, is it safer to give a flu shot or to do metzitzah b’peh?'

But Rabbi Moshe Tendler, a dean at Yeshiva University’s rabbinic school and a professor of biology there, as well as an expert in Jewish medical ethics with a doctorate in microbiology, has long opposed metzitzah b’peh as halachically unnecessary and medically dangerous.

In an interview this week, he said that indications of brain damage in one of the boys whose case is being cited by the Health Department should make people aware of the dangers, besides death, of herpes contracted through metzitzah b’peh.

“I’m convinced that many children have been infected and not diagnosed, and years later they are in special education in the schools and no one knows why,” Rabbi Tendler said.

“Because neonatal herpes has a large variety of presentations, it’s quite likely that cases prior to this recent increased awareness were undiagnosed,” he said. “And because neonatal herpes causes encephalitis, the long-term effects of that infection will be lifelong, including neurological impairment.”

The only reason the city Health Department didn’t impose an outright ban on metzitzah b’peh, he said, is because it would be nearly impossible to enforce, with most ritual circumcisions taking place in private homes and in synagogues.

Dr. John Santelli, a pediatrician and chair of the department of population and family health at Columbia University’s Mailman School of Public Health, said “it’s difficult when there’s a potential clash between religious values and medical information, but it’s really important that parents know, and for the commissioner to take the position that this is a dangerous practice.”

Health departments have learned from dealing with HIV-AIDS that “in public health you have to start with education, with a community and its leaders,” Santelli said. While the health commissioner has broad latitude protecting public health, in some cases amounting to police authority, officials “rarely take draconian measures because it alienates the people you want to work with.”

“The commissioner is now throwing the ball back to the Orthodox community and saying ‘how are you going to respond to this?’ ” Santelli said. “I hope we don’t have another tragedy.”

Debra Nussbaum Cohen is a staff writer.Larry Cohler-Esses is editor-at-large.

We are not having this debate. There is no reason anybody, Mohel, Rabbi or whathaveyou should be putting his mouth on a baby boy's penis. PERIOD. End of argument. The fact that some Hassidim are self-righteously defending the practice sickens me. What is wrong with their brains?! I don't care if it is mandated on page 32 of the Talmud, IT MUST END.